Fierce Compassion in Action: Advocating for Babies, Families, and Ourselves

"To heal others, we must first hold ourselves with the same fierce compassion we extend to those in our care. Advocacy for the vulnerable begins with protecting our own humanity—because only when we are whole can we truly create healing spaces for others." - Mary Coughlin

Advocating for Babies, Families, and Ourselves

As clinicians, we are taught to pour ourselves into others—to heal, support, and advocate tirelessly for the vulnerable. But how often do we turn that same energy inward? Kristen Neff’s Fierce Compassion has been a revelation. It’s a reminder that compassion isn’t just soft and nurturing—it can also be fierce, bold, and protective.

For those of us practicing Trauma-Informed Developmental Care (TIDC), this duality—tenderness and strength—is foundational. We advocate fiercely for our tiniest patients while creating spaces of safety and trust for their families. Yet, how often do we extend the same fierce compassion to ourselves and our colleagues?

Here’s how the principles of Fierce Compassion align with TIDC and Caring Science, alongside practical applications and case studies to bring them to life.

The Dual Faces of Compassion: Fierce and Tender

Neff describes compassion as having two faces:

• Tender Compassion soothes, comforts, and nurtures.

• Fierce Compassion protects, provides, and motivates.

Both are essential, and the balance between them mirrors the balance clinicians must strike daily. In TIDC, tender compassion shows up in nurturing babies and supporting parents with empathy. Fierce compassion emerges when we advocate for systemic change, push back against inequities, or speak up for families who feel silenced.

Case Study: Protecting a Baby’s Healing Environment

A NICU nurse notices that a baby under her care is consistently being interrupted during sleep cycles by non-urgent medical checks. Recognizing the impact of disrupted sleep on neurodevelopment, she advocates for the unit to adjust routines to better align with the baby’s natural sleep rhythms.

• Tender Compassion: The nurse explains her concerns to colleagues and parents with empathy, validating their perspectives.

• Fierce Compassion: She courageously addresses institutional norms, presenting research to support the changes and offering solutions that balance safety and sleep protection.

Practical Tip:

When advocating for a baby’s needs, anchor your approach in both tender and fierce compassion. Combine empathy for parents and staff with a firm commitment to the baby’s best interests.

Fierce Compassion for Ourselves: Resisting Burnout

Neff emphasizes that fierce self-compassion is just as critical as the compassion we extend to others. For clinicians, this means:

• Setting Boundaries: Recognizing when to say no to protect your energy and well-being.

• Acknowledging Your Worth: Understanding that your needs and feelings are just as valid as those you care for.

• Taking Action for Yourself: Prioritizing rest, connection, and healing without guilt.

Case Study: A NICU Nurse Facing Compassion Fatigue

After months of high patient loads and emotionally intense cases, a nurse begins to feel detached and irritable—a sign of compassion fatigue. She decides to set boundaries by stepping back from additional shifts, engages in peer support groups, and schedules regular mindfulness practices into her routine.

• Fierce Compassion: She protects her own well-being by addressing the fatigue proactively.

• Tender Compassion: She reminds herself that taking care of her needs is essential to providing high-quality care for others.

Practical Tip:

Reflect on your current boundaries. Are you protecting your energy as fiercely as you protect your patients? Commit to one actionable step this week to nurture your own well-being.

Fierce Compassion for Families: Empowering Their Voices

Fierce compassion is also about empowering families as advocates for their babies. It’s giving parents the tools and confidence to speak up, ask questions, and become active participants in their child’s care. This aligns with TIDC’s principles of Empowerment, Voice, and Choice.

Case Study: Supporting a Family’s Advocacy Journey

A mother of a premature infant expresses concerns about her baby’s 'feeding tolerance'. Initially hesitant to speak up, she feels intimidated by the medical team’s expertise. A social worker notices her hesitancy and takes time to validate her observations, explain her baby’s care plan in accessible language, and encourage her to ask questions.

• Tender Compassion: The social worker listens without judgment, honoring the mother’s perspective.

• Fierce Compassion: She ensures the mother’s voice is heard during the next care team meeting, advocating for collaborative solutions.

Practical Tip:

Encourage families to participate actively in their baby’s care. Create spaces where they feel empowered to ask questions, share observations, and express concerns without fear of judgment.

Fierce Compassion in the NICU: Protecting the Vulnerable

In the NICU, fierce compassion is advocacy in action. It’s about standing up for the core measures of TIDC—ensuring protected sleep, managing pain and stress, and creating healing environments—even when systemic challenges make it difficult.

Practical Application: Team Advocacy for TIDC Practices

Host a team reflection session where clinicians identify areas where TIDC practices could be better implemented. For example, discuss how noise levels impact the healing environment and brainstorm ways to reduce auditory stress for babies and families.

• Tender Compassion: Foster an open, nonjudgmental space for discussion.

• Fierce Compassion: Translate these reflections into actionable unit-wide changes, advocating for the resources needed to sustain them.

Fierce Compassion as a Call to Action

Kristen Neff’s Fierce Compassion reminds us that the best care comes not from self-sacrifice, but from a balanced approach—nurturing and protecting, giving and receiving. For clinicians practicing TIDC, this duality is a powerful tool for creating systems that heal not just babies and families, but also ourselves.

Next Steps: Embodying Fierce Compassion in TIDC

Feeling inspired to bring fierce compassion into your TIDC journey? Here’s how to start:

1. Practice Self-Compassion: Reflect on one way you can fiercely protect your own well-being this week.

2. Host a Team Workshop: Discuss Fierce Compassion and its relevance to your NICU or practice. Use the case studies above as conversation starters.

3. Join the TIP Program: Learn how to integrate compassion—fierce and tender—into every aspect of your work. The Trauma-Informed Professional (TIP) program equips you with the science, skills, and soul to transform care for babies, families, and yourself. Click here to learn more.

4. Lead by Example: Model fierce compassion by advocating boldly for systemic changes while nurturing a culture of empathy and trust.

Transformation begins with small steps. Let’s commit to caring for babies, families, and ourselves with both tenderness and strength. Together, we can create a future where every interaction—whether tender or fierce—reflects the heart of TIDC.

Take care and care well,

Mary